Healthcare Provider Details

I. General information

NPI: 1093777427
Provider Name (Legal Business Name): LYLE E BEARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 07/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3589 LAFAYETTE PKWY
FLOYDS KNOBS IN
47119-9760
US

IV. Provider business mailing address

PO BOX 950238
LOUISVILLE KY
40295-0238
US

V. Phone/Fax

Practice location:
  • Phone: 812-949-6264
  • Fax: 812-949-5073
Mailing address:
  • Phone: 812-949-5077
  • Fax: 812-949-5073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01033730A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number24109
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number01033730A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier100086780B
Identifier TypeMEDICAID
Identifier StateIN
Identifier Issuer
# 2
Identifier64241094
Identifier TypeMEDICAID
Identifier StateKY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: